The Expert Committee recommended the deletion of streptomycin powder for injection from the core list of the EML as a first-line antituberculosis treatment option, noting the advice from the WHO TB department that it is no longer recommended as first-line treatment.
The Committee noted that streptomycin remains in the Complementary List of the EML and EMLc for second-line use in multidrug-resistant (MDR-TB) tuberculosis.
Streptomycin is currently included in the core list of the EML under Section 6.2.4 for first-line treatment of tuberculosis. It is also included in the Complementary List of the EML and EMLc as a reserve second-line drug for MDR-TB.
Public health relevance
In February 2017, the WHO Guidelines Review Committee approved the new WHO Guidelines for the treatment of drug-susceptible tuberculosis and patient care, 2017 update (in press at that time). The updated guidelines no longer recommend the use of streptomycin as a component of first-line antituberculosis therapy but reserve its use as a potential option in second-line regimens for drug-resistant disease.
Cost / cost effectiveness
Refer to the summary for deletion of ofloxacin for recommendations regarding the use of streptomycin in MDR-TB and rifampicin-resistant (RR-TB) disease in current WHO guidelines.
The current listing of streptomycin on the Complementary List of the EML and EMLc as a reserve second-line drug for treatment of MDR-TB will be retained.